HomeMy WebLinkAboutPlumbing Permit #12-1356 � �
DATE TIME
CITY OF PRIOR LAKE q
fNSPECTiON NOTtCE SCHEDULED (" I y _
ADDRESS / t'"lO � fo //l �'� � � v � / /L t.
OWNER CONTR.
PHONE NO. PERMIT NO. / � "�/3-s
O FOOTING ❑ PLUMBING RI ❑ EXIGRAD/FIILING
❑ FOUNDATION ❑ MECH RI ❑ COMPLAINT
O FRAM(NG ❑ WATER HOOKUP ❑ F(REPLACE RI
❑ INSULATION ❑ SEWER HOQKUP ❑ FIREPLACE FINAL
❑ FINAL O PLUMSING FiNAL O GAS�E AI TST
D SITE INSPECTION ❑ MECH FINAI � � �
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COMMENTS:
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❑ WORK SA°CISFACYORY, PROCEED
❑ CORREC7 ACTION AP1D PROCEED
❑ CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
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lnspector. Owner/Contr.
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTSARE FOR YQUR PERSONAL HEALTH & SAFETY!
uvsnon
o � rRI �� Date Rec'd
F , � CITY OF PRIOR LAKE PLUMBING PERMIT
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� 1. Blue F��e pERMIT NO. j
2. Gold City /�..�/`�� �
3. Yellow Ar�licant
lease e or ' t and si at bottom
ADDRESS � � ZONIl�TG (office use)
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LEGAL DESCRIPTION (otiice use only)
LOT BLOCK ADDITION PID
OWNER � (Phone) �
(Name)
(Address) -
APPLICANT P� O0���8
(Name) (Phone)
(Address) 3,�j.,7(l flnrlci Rnaci
(Address) ��� MN 55123 ��iri� (Zip Code)
(Contact Person) G�. V1 (Phone)
APPLICANT SIGNATURE DATE l ��
APPLICANT PLEASE COMPLETE BELOW
uanti T e of Fixture uanti T e of Fizture
Bath Tub with or without shower Rou -
Dishwasher ater Heate
Floor Drain er Softener
Lavato Bathroom Sink Stand Pi e Washin Machine
Laund Tra 1 or 2 com artment sink Sewa e E'ector
Shower Stall Backflow Assembl
Sinks Backflow Assembl Test
Bar Sink Lawn S rinkler
Water Closet Toilet Other
FEESCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a$49.50 minimum Residential, New One & Two-Family $149.50
Residential, Additions & Alterations $49.50
Estimated Cost $2!� f- � S
,, Buildin Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended PLUMBING PERMIT FEE $
until june 30, 2013, STATE SURCHARGE $ .50
The minimum surcharge for a TOTAL PERMIT FEE $ �,�
"fixed fee" permit is $5.00
i nis App��canon necomes x uur nu,.uing Permit When Approved Paid ��� Receipt No. 76 �
Buildine Official Date Date � y B �
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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